Expert on infectious disease explains why SGH should have informed members of public about Hep-C outbreak earlier

It’s not often that I find something in ST that I find worth reading and praising. But ST published something yesterday that I found to be praiseworthy. The article is Prof Paul Ananth Tambyah’s assessment of the report by the Independent Review Committee (IRC). Why do I think that ST is praiseworthy for publishing the article? Two reasons.

Firstly, the article is critical of the IRC report and the way SGH and MOH handled the Hep-C outbreak. Specifically, Prof Tambyah highlighted that:

“There are a series of steps which needs to be taken to elucidate which of these is the cause of an outbreak and these are illustrated in Annex A of the Independent Review Committee Report.

They include defining cases, doing a case control study to identify risk factors for infection and testing the hypotheses generated. The one step not listed in the Annex A list that was also not done by the SGH infection control team was a broad sweep to determine the extent of the infection by making a public call for those potentially infected to come forward for testing and treatment. (emphasis mine)

For some reason, that was delayed and the SGH leadership is now paying the price for that delay.”

So the IRC report left out a critical step in the Annex that listed the steps that need to be taken to mitigate the effects of the outbreak. In highlighting this, Prof Tambyah also explained why there was a need for SGH to have informed the public about the outbreak a lot earlier than when it actually did. So now we know. Not only were there no reasons for the delay to inform the public, there were actually very good reasons to inform the public much sooner.

Prof Tambyah also seemed to be subtly suggested why a Committee of Inquiry (COI) might have been more appropriate:

“Finally, most modern outbreak investigations use DNA/RNA-fingerprinting or molecular epidemiology to link viruses or bacteria isolated from outbreaks.

This is another striking feature of the SGH outbreak – the isolates were almost identical, which strongly suggests a single point source outbreak (such as repeated contamination of saline solutions from the same index case). A general breakdown in hospital hygiene would usually result in a multiplicity of strains reflecting the different viruses present in different patients in the wards or hospital at the time.

The IRC had a difficult job attempting to do a high-profile investigation in a short period of time. It is unclear if the committee had the benefit of information available only to law enforcement about who had access to various fluids (emphasis mine). This highlights some of the problems in trying to prevent future occurrences.”

If I understand this correctly, Prof Tambyah is suggesting that the outbreak wasn’t just due to poor hygiene (e.g. blood on walls not cleaned off properly, hospital trolleys and carts not disinfected thoroughly), but that there was a single source of the outbreak. But because the IRC likely did not have access to the necessary information, it appeared unable to determine conclusively the source of the outbreak. However, a COI would have the necessary power to gain access to the information available to law enforcement agencies about who had access to various fluids and thus better placed to identify the source and cause of the outbreak.

The second reason why I think ST is praiseworthy for publishing this article is because Prof Tambyah is a member of SDP. Prof Tambyah was a member of the SDP team that contested in the Holland-Bukit Timah GRC in the last General Election. It is uncommon for ST to publish articles by members of the opposition that are critical of the establishment without any qualifying statements. But it seems that in this case, ST published what Prof Tambyah had to say without its own qualifying statement. I think this bodes well. It shows that government institutions (of which ST is one) is some times willing to take views from the Opposition. Especially if the view is about infectious disease and it comes from an expert in infectious diseases. This is aligned to the spirit of what DPM Tharman said about taking views from everyone, including the opposition.

I hope that MOH heeds Prof Tambyah’s advice as it moves forward from this episode:

“I hope that the reaction will not be more bureaucracy but rather strengthening of existing surveillance systems and empowering healthcare workers at all levels to do what we are called to do – look after sick patients without doing them any harm, as the medical adage goes: Primum non nocere, first do no harm.”

Indeed, I hope that MOH does a systemic review of ALL hospitals and strengthen the systems and empower healthcare workers at all levels to minimise the possibility of such outbreaks from happening again.

One thought on “Expert on infectious disease explains why SGH should have informed members of public about Hep-C outbreak earlier”

Prof Tambyah’s presentation of his opinions and recommendations are certainly much more than just noteworthy. In my opinion, this IS calling a spade a spade. More of the same from other quarters would be most welcome. If this wish does not turn out to be merely a pipe dream we may yet have ourselves that elusive effective opposition ….. one which is responsible, rational and above all else, principally intent on preserving all that is good and wholesome in our little red dot regardless of which side of the great divide we find it.